The official blog for the U.S. Medicare program. For more information, please visit www.medicare.gov

Category Archives: Affordable Care Act

If you’ve ever found yourself skipping a day of your medication or cutting your pills in half to make your supply last a little longer, there’s help. Medicare has a special program called “Extra Help.” If you have limited income and resources you can sign up to get help paying things like monthly premiums, annual deductibles, and prescription copayments in your Medicare drug plan. Even if you’re not sure you’d qualify, it’s worth filling out an application to see.

Many people with Medicare may be eligible for the Extra Help program but don’t even know it. Are you or a family member one of them?

These are 4 simple ways to protect your identity and personal information from Medicare fraud, but they can be difficult to do if you’re caught off guard.

During Medicare Open Enrollment – between now and December 7 – you can expect to hear a lot about Medicare. You might be hearing a lot about the Health Insurance Marketplace this fall. That’s because the Marketplace Open Enrollment period overlaps with the Medicare Open Enrollment period.

Open Enrollment is a great time for you to review and compare your Medicare choices and make sure you have the coverage that fits your needs. Unfortunately, it’s also a popular time for Medicare fraud schemes.

Here are a few reminders to keep you safe from those who might not have your best interests in mind:

You’ll be hearing so much about Medicare during Open Enrollment, that it may not surprise you to get phone calls or visits to your house from people selling Medicare plans.

It’s illegal for someone to call and ask for your Medicare number, Social Security number, or bank or credit card information. A Medicare representative or a private insurance plan working with Medicare will never call and ask for this information, and we will never call you or come to your home uninvited to sell Medicare products. And remember, it’s against the law for someone who knows that you have Medicare to sell you a Marketplace plan.

2. Be suspicious of people offering free medical equipment or services.

Anyone who offers you free medical equipment or services and then requests your Medicare number is tricking you – if it’s really free, they don’t need your Medicare number. It’s illegal, and it’s not worth it!

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Have you ever pumped gas into your car from a station just around the corner from home even though it’s a bit more expensive than the one in town? Most of us have made decisions to do or not do something based on convenience.

The same is true when it comes to choosing a health plan: convenience matters. So in addition to cost, coverage, and benefits, here are some other things you may want to consider as you compare Medicare options this year:

Doctor and hospital choice

You want to be comfortable with the people you’re working with, especially when it comes to something as private as your health. Do the doctors you know accept your coverage? Where are the doctors’ offices? What are their hours? Do they often keep you waiting?

Pharmacy access

Is the pharmacy you use included in your drug plan’s network? Do they use e-prescribing? Can you get refills by mail? Remember that plan networks can change from year to year. If it’s important to you to stay with the same pharmacy, it’s worth checking to make sure they’ll still be in your plan’s network.

Travel

Maybe you travel a lot, or spend part of the year in a different state. If you do, make sure you know whether your coverage will travel with you.

Quality

Ask yourself whether you’re truly satisfied with your medical care. Not all health care is created equal, and the doctors, hospitals and facilities you choose can impact your health. Look for plans with a 5‑star performance rating — the right expertise and care may help speed your recovery and improve your outcomes.

Your time is valuable — and so is your health. Only you know what mix of coverage and convenience is most important to you and your family.

We’re working hard to make sure you have choices in the way you get the Medicare benefits you’ve earned – and we want you to be comfortable. Use the Medicare Plan Finder to look at all of the health and drug plan options in your area.

In the three years since the Affordable Care Act became law, the slower growth of health care costs is saving money in Medicare and the private insurance market, helping to curb previously skyrocketing premiums and making Medicare stronger.

The nonpartisan Congressional Budget Office recently estimated that Medicare and Medicaid spending would be 15 percent less — or about $200 billion— in 2020 than was previously projected, thanks to this slower growth. Medicare spending per beneficiary rose by just 0.4% in 2012, while Medicaid spending per beneficiary actually dropped by 1.9% last year. We are making Medicare stronger, too, by spending smarter, promoting coordinated care, and fighting fraud. Not only does this ensure that taxpayer dollars are spent wisely. It means that those who count on Medicare — our grandparents, parents, our friends, and neighbors – will have it for years to come.

Today, we are announcing that thanks to the Affordable Care Act, more than 6.3 million seniors and people with disabilities on Medicare have saved more than $6.1 billion on prescription drugs since the health care law was enacted three years ago. This is the result of the law’s closing of the prescription coverage gap known as “the donut hole.”

Nearly 3.5 million people with Medicare saved an average of more than $706 each on their prescriptions in 2012.

In the case of Helen Rayon of Pennsylvania, the savings on her medications is enough to help her contribute to the education of her grandson. She says: “I take seven different medications. Getting the donut hole closed … gives me a little more money in my pocket.” Watch a video to learn more about Helen.

David Lutz, a community pharmacist from Hummelstown, PA, described his elderly customers, “splitting pills, taking doses every other day, missing doses, stretching their medications.” But he says this has begun to change with the savings resulting from the Affordable Care Act, and that’s good for their health as well as their budgets.

After the law was passed, the Affordable Care Act provided a one-time $250 check for people with Medicare who reached the Part D prescription drug coverage gap in 2010. Since then, individuals in the donut hole have continued to receive savings on prescription drugs. In 2013 individuals in the donut hole are saving over 50% off of the cost of branded drugs. The savings on both brand name and generic drugs will continue to increase until the coverage gap is closed in 2020.

Along with savings on their medications, American seniors have also benefited from access to vital preventive services — such as mammograms, cholesterol checks, cancer screenings, and annual wellness visits — with no Part B coinsurance or deductibles. In 2012, more than 34 million seniors and people with disabilities with Medicare received at least one free preventive service. Having easier access to preventive services without worrying about the cost helps seniors stay healthier and identify health conditions before they become more serious and costly.

Helen works as a health-and-wellness coordinator at a senior center, arranging for health and fitness activities for seniors older than herself. She knows they struggle with the costs of staying healthy. “If it weren’t for the health care reform, many of our seniors would not get to a doctor,” to get a check up, Helen says. “It is expensive for us to keep good health.”

Affordable Care Act initiatives are also ensuring that if Medicare beneficiaries do end up in the hospital that their care is coordinated and they stay out of the hospital once they’re discharged. This also gives Medicare beneficiaries – and other taxpayers – more value for their health care dollars. In fact, hospital readmissions in Medicare have fallen for the first time on record, resulting in 70,000 fewer readmissions in the last half of 2012.

The Affordable Care Act is helping us keep our moral commitment to ensure that our grandparents and other seniors get the high-quality, affordable health care and security they need and deserve.

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It’s that time of year again. With the beginning of fall comes the beginning of flu season.

Get your flu shot early and stay healthy! It’s free for people with Medicare, once per flu season in the fall or winter, when given by doctors or other health care providers (such as senior centers and pharmacies) that take Medicare.

Millions of Americans are enjoying improved Medicare coverage thanks to the Affordable Care Act. More people are getting preventive services to keep them healthy, and people with high prescription drug costs are seeing the coverage gap “donut hole” starting to close. Here are the latest numbers from the past few months:

July:

Through the end of July, 1.28 million Americans with Medicare have received discounts on brand name drugs in the Medicare Part D coverage gap — up from 899,000 through the end of June and 478,000 through the end of May.

These discounts have saved seniors and people with disabilities a total of$660 million, including $199 million in July alone!

For state-by-state information on the number of people who are benefiting from this discount in 2011, visit this page.

August:

Through the end of August, over 18.9 million people with Original Medicare, or 55.6 percent, have received one or more free preventive services.

During the same time period, over 1.2 million Americans with Original Medicare have taken advantage of Medicare’s new free Annual Wellness Visit, up from 1.06 million in July.

For state-by-state information on the numbers of people who are utilizing preventive services in 2011, visit this page.

Over the coming years, provisions of the Affordable Care Act will help close the coverage gap completely. Here is a sense of what people with Medicare can look forward to:

2013: Paying less and less for your brand-name Part D prescription drugs in the coverage gap.

2020: The coverage gap will be closed, meaning there will be no more “donut hole,” and people with Medicare will pay only 25% of the costs of their drugs until they reach the yearly out-of-pocket spending limit.

The chart below shows what people with Medicare prescription coverage will pay over time:

If you or a loved one has ever had the unfortunate experience of having a chronic or serious illness, you’ve experienced the frustration of our fragmented health care system. Just when you are feeling your worst, there you are in the doctor’s office or hospital room, repeating the same information time and time again, sitting through the same medical test more than once, and trying to track down lost or unavailable medical charts. These are all aspects of our current health care system we could each do without.

This can be a particular problem for the more than half of Medicare beneficiaries with five or more chronic conditions such as diabetes, arthritis, and kidney disease. These patients often receive care from multiple physicians and in multiple sites. A failure to coordinate care can lead to patients not getting the care they need or receiving duplicative care. This lack of coordination also increases their risk of suffering medical errors, such as receiving prescriptions for medications that ought not to be taken together. It can also cause complications that lead to needless hospital stays. Nearly one in five Medicare patients discharged from the hospital is readmitted within 30 days – a readmission many patients could have avoided if their care outside of the hospital had been better coordinated.

Improving coordination and communication among physicians and other providers and suppliers will help improve the care Medicare beneficiaries receive, while also helping lower costs. Numerous studies have shown that better care often costs less, because coordinated care helps to ensure that the patient receives the right care at the right time.

Thanks to the Affordable Care Act, the Department of Health and Human Services (HHS) today released proposed new rules to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). ACOs are designed to create and support a team of health care providers who treat individual patients by working together across care settings.

Over the last months, CMS has conducted extensive outreach to patient advocates, doctors, nurses, hospitals, health plans, employers, and other interested stakeholders to hear their thinking about the best way to shape this effort. We will continue to seek feedback on the proposed rules released today so that the final rules reflect the broadest consensus on how to improve care for people with Medicare and to provide a model for private payers to draw upon. We look forward to working with patients and care providers to build the most patient friendly and cost-effective health care system achievable

Under the proposal, ACO teams of doctors, hospitals and other health care providers and suppliers working together would coordinate and improve care for patients with Original Medicare. ACOs would have to meet high quality standards in five key areas:

An ACO will be rewarded for providing better care and investing in bettering the health and lives of patients. ACOs are not just a new way to pay for care. They are a new model for the organization and delivery of care. Accountable Care Organizations are designed to lift the burden of fragmented and disconnected care from patients, while improving the partnership among patients, doctors, hospitals and other providers of care in making health care decisions.